In diagnostic radiology a revolution has taken place over the last decade with the development of computer-based imaging (CT, MR). Such technologies are now available routinely even in medium-sized ...radiology departments. In radiotherapy departments, however, computer applications have often been limited to calculation of dose distributions on CT images and administrative tasks. The last few years applications are emerging and utilize the full power of modern computer technology and promise to revolutionize treatment planning and execution in everyday radiotherapy. The authors present their view on some of these applications and the way they may push ahead frontiers in clinical radiotherapy.
Background
The impact of cardiorespiratory comorbidity on operative outcomes after esophagectomy remains controversial. This study investigated the effect of cardiorespiratory comorbidity on ...postoperative complications for patients treated for esophageal or gastroesophageal junction cancer.
Patients and Methods
A European multicenter cohort study from five high-volume esophageal cancer centers including patients treated between 2010 and 2017 was conducted. The effect of cardiorespiratory comorbidity and respiratory function upon postoperative outcomes was assessed.
Results
In total 1590 patients from five centers were included; 274 (17.2%) had respiratory comorbidity, and 468 (29.4%) had cardiac comorbidity. Respiratory comorbidity was associated with increased risk of overall postoperative complications, anastomotic leak, pulmonary complications, pneumonia, increased Clavien–Dindo score, and critical care and hospital length of stay. After neoadjuvant chemoradiotherapy, respiratory comorbidity was associated with increased risk of anastomotic leak odds ratio (OR) 1.83, 95% confidence interval (CI) 1.11–3.04, pneumonia (OR 1.65, 95% CI 1.10–2.47), and any pulmonary complication (OR 1.52, 95% CI 1.04–2.22), an effect which was not observed following neoadjuvant chemotherapy or surgery alone. Cardiac comorbidity was associated with increased risk of cardiovascular and pulmonary complications, respiratory failure, and Clavien–Dindo score ≥ IIIa. Among all patients, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio > 70% was associated with reduced risk of overall postoperative complications, cardiovascular complications, atrial fibrillation, pulmonary complications, and pneumonia.
Conclusions
The results of this study suggest that cardiorespiratory comorbidity and impaired pulmonary function are associated with increased risk of postoperative complications after esophagectomy performed in high-volume European centers. Given the observed interaction with neoadjuvant approach, these data indicate a potentially modifiable index of perioperative risk.
Weekly chemotherapy and concurrent radiotherapy for 5 weeks before curative resection in patients with esophageal or esophagogastric-junction cancer resulted in a pathologically complete response in ...29% of patients and doubled the median overall survival to 4 years.
With new diagnoses in more than 480,000 patients annually, esophageal cancer is the eighth most common cancer worldwide.
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It is a highly lethal disease, causing more than 400,000 deaths per year.
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The incidence of esophageal adenocarcinoma is rapidly rising, whereas that of squamous-cell carcinoma remains unchanged.
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Despite adequate preoperative staging, 25% of patients treated with primary surgery have microscopically positive resection margins (R1), and the 5-year survival rate rarely exceeds 40%.
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The role of neoadjuvant chemoradiotherapy has been debated for several decades. In most randomized trials, no survival benefit could be shown, and the trials were criticized for inadequate trial . . .
In 2004 and 2005, the shell-type supernova remnants RX J1713.7–3946 and RX J0852.0–4622 were observed and detected with the complete H.E.S.S. array, a system of four Imaging Cherenkov Telescopes ...located in Namibia and dedicated to the observations of γ-rays above 100 GeV. The energy spectra of these two sources have been measured over a wide energy range and revealed an integral flux above 1 TeV similar to that of the Crab Nebula. Their morphologies were resolved with high accuracy with H.E.S.S. and exhibit a striking correlation with the X-ray images, thereby pioneering a technique of unambiguously identifying spatially extended γ-ray sources. The results of the observations will be presented. Similarities and differences between these two sources will be pointed out as well as possible implications.
The ATLAS detector at CERN's Large Hadron Collider (LHC) will be exposed to proton-proton collisions from beams crossing at 40 MHz. A three-level trigger system will select potentially interesting ...events in order to reduce the readout rate to about 200 Hz. The first trigger level is implemented in custom-built electronics and makes an initial fast selection based on detector data of coarse granularity. It has to reduce the rate by a factor of 104 to less than 100 kHz. The other two consecutive trigger levels are in software and run on PC farms. We present an overview of the first-level central trigger and the muon barrel trigger system and report on the current installation status. Moreover, we show analysis results of cosmic-ray data recorded in situ at the ATLAS experimental site with final or close-to-final hardware.
CD8(+) T-cell responses against latent viruses can cover considerable portions of the CD8(+) T-cell compartment for many decades, yet their initiation and maintenance remains poorly characterized in ...humans. A key question is whether the clonal repertoire that is raised during the initial antiviral response can be maintained over these long periods. To investigate this we combined next-generation sequencing of the T-cell receptor repertoire with tetramer-sorting to identify, quantify and longitudinally follow virus-specific clones within the CD8(+) T-cell compartment. Using this approach we studied primary infections of human cytomegalovirus (hCMV) and Epstein Barr virus (EBV) in renal transplant recipients. For both viruses we found that nearly all virus-specific CD8(+) T-cell clones that appeared during the early phase of infection were maintained at high frequencies during the 5-year follow-up and hardly any new anti-viral clones appeared. Both in transplant recipients and in healthy carriers the clones specific for these latent viruses were highly dominant within the CD8(+) T-cell receptor Vβ repertoire. These findings suggest that the initial antiviral response in humans is maintained in a stable fashion without signs of contraction or changes of the clonal repertoire.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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